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Stimulation-induced side effects in the posterior subthalamic area: distribution, characteristics and visualization
Department of Pharmacology and Clinical Neuroscience, Section of Neurosurgery, Umeå University, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology. (MINT)
Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. (MINT)ORCID iD: 0000-0002-0012-7867
Department of Pharmacology and Clinical Neuroscience, Section of Neurosurgery, Umeå University, Sweden.
2013 (English)In: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print), ISSN 0303-8467, E-ISSN 1872-6968, Vol. 15, no 1, 65-71 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The posterior subthalamic area (PSA) is an emerging but relatively unexplored target for DBS treatment of tremor. The aim of the study was to explore the area further by evaluating the spatial distribution and the characteristics of stimulation-induced side effects in this area. Methods: Twenty-eight patients with essential tremor (ET) implanted with 33 DBS electrodes were evaluated concerning stimulation-induced side effects by testing each contact separately one year after surgery. The location of the side effects were plotted on axial slides of the Morel Stereotactic Atlas and a 3-dimensional model of the area for visualization was created. Results: Visualization of the contacts eliciting stimulation-induced side effects demonstrated that identical responses can be elicited from various points in the PSA and its vicinity. The majority of contacts inducing muscular affection and cerebellar symptoms, including dysarthria, could not be attributed to an effect on the internal capsule. Paresthesias, affecting various body parts were elicited throughout the area without a clear somatotopic pattern. Conclusion: Stimulation-induced side effects in the PSA and its vicinity are difficult to attribute to certain anatomical areas as the same response can be induced from various locations, and are thus of limited localizing value.

Place, publisher, year, edition, pages
Elsevier, 2013. Vol. 15, no 1, 65-71 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-70088DOI: 10.1016/j.clineuro.2012.04.015ISI: 000312576300012OAI: oai:DiVA.org:liu-70088DiVA: diva2:435389
Available from: 2011-08-18 Created: 2011-08-18 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Modelling, Simulaltion, and Visualization of Deep Brain Stimulation
Open this publication in new window or tab >>Modelling, Simulaltion, and Visualization of Deep Brain Stimulation
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Deep brain stimulation (DBS) is an effective surgical treatment for neurological diseases such as essential tremor, Parkinsonʹs disease (PD) and dystonia. DBS has so far been used in more than 70 000 patients with movement disorders, and is currently in trial for intractable Gilles de la Tourette’s syndrome, obsessive compulsive disorders, depression, and epilepsy. DBS electrodes are implanted with stereotactic neurosurgical techniques in the deep regions of the brain. Chronic electrical stimulation is delivered to the electrodes from battery-operated pulse generators that are implanted below the clavicle.

The clinical benefit of DBS is largely dependent on the spatial distribution of the electric field in relation to brain anatomy. To maximize therapeutic benefits while avoiding unwanted side-effects, knowledge of the distribution of the electric field in relation anatomy is essential. Due to difficulties in measuring electric fields in vivo, computerized analysis with finite element models have emerged as an alternative.

The aim of the thesis was to investigate technical and clinical aspects of DBS by means of finite element models, simulations, and visualizations of the electric field and tissue anatomy. More specifically the effects of dilated perivascular spaces filled with cerebrospinal fluid on the electrical field generated by DBS was evaluated. A method for patient-specific finite element modelling and simulation of DBS was developed and used to investigate the anatomical distribution of the electric field in relation to clinical effects and side effects. Patient-specific models were later used to investigate the electric field in relation to effects on speech and movement during DBS in patients with PD (n=10). Patient-specific models and simulations were also used to evaluate the influence of heterogeneous isotropic and heterogeneous anisotropic tissue on the electric field during DBS. In addition, methods were developed for visualization of atlas-based and patient-specific anatomy in 3D for interpretation of anatomy, visualization of neural activation with the activating function, and visualization of tissue micro structure. 3D visualization of anatomy was used to assess electrode contact locations in relation to stimulation-induced side-effects (n=331) during DBS for patients with essential tremor (n=28). The modelling, simulation, and visualization of DBS provided detailed information about the distribution of the electric field and its connection to clinical effects and side-effects of stimulation. In conclusion, the results of this thesis provided insights that may help to improve DBS as a treatment for movement disorders as well as for other neurological diseases in the future.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 84 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1384
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70090 (URN)978-91-7393-114-4 (ISBN)
Public defence
2011-09-09, Eken, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2011-08-18 Created: 2011-08-18 Last updated: 2017-02-09Bibliographically approved

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Åström, MattiasWårdell, Karin

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